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Hospitals booking urgent Choose and Book referrals into 'shadow' slots in 'non-existent clinics'

Exclusive: Hospital trusts are booking urgent GP referrals made through Choose and Book into non-existent ‘shadow’ slots before rearranging a real appointment, a Pulse investigation reveals.

The practice, which in some areas affects patients with suspected cancer, was described by the GPC as ‘highly dangerous’ and the Department of Health has already intervened in one trust to ensure its procedures are improved.

The latest concerns about Choose and Book come after Pulse revealed last month that appointments made through the contraversial electronic booking system were being routinely cancelled due to administrative reasons, leaving GPs to cope with angry patients.

University Hospitals Coventry and Warwickshire NHS Trust told Pulse it routinely booked urgent Choose and Book referrals, including two-week cancer referrals, into non-existent Sunday clinics, and then later rebooked the appointment.

A spokesperson said: ‘These types of appointments are booked as a shadow appointment so that the Patient Access Team can easily identify an urgent appointment booking and make contact with the patient to agree a suitable time.’

The trust said its patient administration system could not transfer the site of any suspected cancer from Choose and Book. The spokesperson added: ‘It is imperative the trust has this information in order to report and track two-week-wait patients.’

A number of other trusts also said they used ‘shadow’ appointments. A spokesperson from the Royal Surrey County Hospital said all appointments were booked ‘provisionally’ and patients informed, but they were not accepted until a consultant had reviewed the referral.

Central Manchester University Hospitals NHS Foundation Trust said that for some of its Choose and Book services, including urgent referrals, shadow booking was used to ‘ensure that patients are seen in the correct consultant clinic’.

A spokesperson said: ‘In such cases patients can book a time slot which will subsequently be confirmed or otherwise direct with the patient by the relevant hospital.’

Dr Manoj Pai, a GP in Coventry, said he was concerned because practices could not track urgent referrals.

He said: ‘We won’t know if they have been seen. If something goes wrong patients could slip through the net.’

Dr Paul Cundy, chair of the GPC’s IT subcommittee, said the arrangements were ‘highly dangerous’.

He said: ‘For an urgent referral you need confirmation and action at the other end. Choose and Book doesn’t provide that.

‘If the Government wants doctors in general to use this system for urgent referrals then they need to be offering an indemnity for doctors should the system fail.’

Dr Nigel Watson, chief executive of Wessex LMCs and a GP in the New Forest, said he had raised concerns with a local trust after the LMC discovered patients were being booked into ‘non-existent clinics’.

He said: ‘When we called the trust out on it, they refused to say it happened.’

A Department of Health spokesperson said it would raise the matter with University Hospitals Coventry and Warwickshire NHS Trust: ‘Choose and Book does allow patients who need to be seen urgently or within two weeks to be booked directly into appointments.

‘We have offered to work with the trust concerned and will continue to work with local organisations to help them improve their local Choose and Book processes.’

How ‘shadow’ appointments work

GP makes an urgent referral through Choose and Book

Trust books patient into a dummy appointment – for example, on Sunday

Trust re-books patient into a real appointment

Readers' comments (9)

  • I was under the impression that Choose and Book wasn't used (or reccommended to be used) for urgent two week referrals?

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  • Vinci Ho

    (1) This is nothing new. That was one of the problems from day 1. This article follows the one last week about rejected appointments
    (2) Isn't this another example of driving a wedge to widen the dispute between primary and secondary care??

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  • Should we be surprised? The trusts have been putting patients on an imaginary ward from AED to bump up their 4hr wait target for the last 10 years and I'm yet to hear of anyone being prosecuted for fraud.

    Interestingly Pulse's journalist seems to have evaded the crucial questions: Has this caused delay in appointment (specifically, has this allow the hospital to avoid breaching the 2ww) and has any patient appointment slipped through the net?

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  • ? Big deal, it's better then faxing a referral and two weel means guaranteed 2 least from gp point of view it's a guarantee as its electronically gone through and the trust can't pass the buck back.

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  • Indeed, the use of a DBS CAS with dummy appointments is the one of the most straight forwards ways to support 2WW referrals via Choose and Book. Maybe not the best, but it works, specially when you have to work around PAS limitations.

    Puts the ball in Trust's court, gives the GPs a clear travel and still leaves the Trust with some breathing room to sort out capacity.

    Of course ideal case is just to ensure the real capacity is there in the first place, but the NHS is bad at proactive capacity managment. Beats a fax any day.

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  • Neil Bhatia

    I have never had a problem with faxes.
    Our local trust faxes back straight away to say they have received the referral.
    They have a dedicated 2WW referral line for GPs to use, if needed, and speak to the back office direct.

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  • I agree with previous emails 2pm & 3-30pm. We need the NHS to move away from faxes - crummy output at other end, not that secure - do you really want confirmation faxbacks - not in my view. Faxes Old technology. Use C&B or email. Rest of world is moving away from faxes !

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  • I feel it's a real shame that Pulse decides to devote all these articles to criticising Choose and Book, rather than looking at the actual effect it's had on patient care and what steps have been taken to improve matters. A missed opportunity to increase much needed collaboration between primary and secondary care.

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  • The best way of prioritising referrals is for the consultant to see them and then book the slot. This is impossible with C&B as the slot is booked before the letter is seen, and at the provider end the task of re-prioritisation is acutally near impossible. There is a flip side to urgent appointments being held up by admin - not infrequently I used to read a letter and make it more urgent than the GP had indicated.

    By all means use email; I have for years suggested that all letters from hospital to GP are sent this way to save time and postage/stationery costs, but met fierce resistance from GP colleagues, so gave up trying. C&B is unusable by clinicians at the hospital end. If you must use it, then expect managers to deal with referrals, accept the clinical consequences and contribute to the growing lack of dialogue across the interface. WE are not a travel booking system!

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